TY 2012 Form 990PF

- TIN:

Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation

Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0052

2012

Open to Public Inspection

For calendar year 2012, or tax year beginning 06-01-2012 , and ending 05-31-2013

Name of foundation
THE FARMINGTON HOME FOR AGED PEOPLE

Number and street (or P.O. box number if mail is not delivered to street address)204 MAIN STREET Room/suite

City or town, state, and ZIP code
FARMINGTON, ME04938

A Employer identification number

01-0217212

B Telephone number (see instructions)

(207) 778-4745

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address changeName change

D 1. Foreign organizations, check here ............. bullet

2. Foreign organizations meeting the 85% test,
check here and attach computation ........... bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trustOther taxable private foundation

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$4,040,104J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

E If private foundation status was terminated
under section 507(b)(1)(A), check here ......... bullet

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ......... bullet

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(c) Adjusted net income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	8,075
2	Check
3	Interest on savings and temporary cash investments	166		166	166
4	Dividends and interest from securities......	69,510		69,510	69,510
5a	Gross rents..............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		48,518
b	Gross sales price for all assets on line 6a 416,083
7	Capital gain net income (from Part IV, line 2)...			48,518
8	Net short-term capital gain.........				48,518
9	Income modifications...........
10a	Gross sales less returns and allowances
b	Less: Cost of goods sold....
c	Gross profit or (loss) (attach schedule).....
11	Other income (attach schedule).......		715,549
12	Total. Add lines 1 through 11........	841,818		118,194	118,194
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......	410,672		10,000	10,000	400,672
15	Pension plans, employee benefits.......	5,355				5,355
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		9,680			9,680
c	Other professional fees (attach schedule)....		21,583	13,998	13,998	7,585
17	Interest...............	2,804				2,804
18	Taxes (attach schedule) (see instructions)		39,796	1,685	1,685	38,111
19	Depreciation (attach schedule) and depletion...		55,373
20	Occupancy..............	57,292		2,865	2,865	54,427
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		273,917			272,649
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	876,472		28,548	28,548	791,283
25	Contributions, gifts, grants paid........	0				0
26	Total expenses and disbursements. Add lines 24 and 25	876,472		28,548	28,548	791,283
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-34,654
b	Net investment income (if negative, enter -0-)			89,646
c	Adjusted net income (if negative, enter -0-)...				89,646

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11289X Form 990-PF (2012)

Form 990-PF (2012)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing...............	143,180	45,030	45,030
	2	Savings and temporary cash investments..........	66,529	24,249	24,249
	3	Accounts receivable 7,833
		Less: allowance for doubtful accounts	6,726	7,833	7,833
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see page 15 of the
		instructions)....................
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use...............
	9	Prepaid expenses and deferred charges...........	927	2,285	2,285
	10a	Investments—U.S. and state government obligations (attach schedule)	309,621	274,460	274,460
	b	Investments—corporate stock (attach schedule)........	1,570,002	1,734,222	1,734,222
	c	Investments—corporate bonds (attach schedule)........	384,390	532,332	532,332
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans..............
	13	Investments—other (attach schedule)...........
	14	Land, buildings, and equipment: basis 1,418,425
		Less: accumulated depreciation (attach schedule) 1,125,121	315,789	293,304	1,418,425
	15	Other assets (describe )	2,535	1,268	1,268
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	2,799,699	2,914,983	4,040,104
	17	Accounts payable and accrued expenses..........	12,809	19,225
	18	Grants payable...................
	19	Deferred revenue..................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......	155,000	105,000
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22)..........	167,809	124,225
		Foundations that follow SFAS 117, check here
		and complete lines 24 through 26 and lines 30 and 31.
	24	Unrestricted....................	2,629,952	2,788,268
	25	Temporarily restricted................	1,938	2,490
	26	Permanently restricted................
		Foundations that do not follow SFAS 117, check here
		and complete lines 27 through 31.
	27	Capital stock, trust principal, or current funds.........
	28	Paid-in or capital surplus, or land, bldg., and equipment fund
	29	Retained earnings, accumulated income, endowment, or other funds
	30	Total net assets or fund balances (see page 17 of the
		instructions)....................	2,631,890	2,790,758
	31	Total liabilities and net assets/fund balances (see page 17 of
		the instructions)..................	2,799,699	2,914,983

Part III	Analysis of Changes in Net Assets or Fund Balances
1	Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
	with end-of-year figure reported on prior year’s return)...............	1	2,631,890
2	Enter amount from Part I, line 27a.....................	2	-34,654
3	Other increases not included in line 2 (itemize)	3	193,522
4	Add lines 1, 2, and 3..........................	4	2,790,758
5	Decreases not included in line 2 (itemize)	5
6	Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.	6	2,790,758

Form 990-PF (2012)

Page 3

Part IV

Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1a
b
c
d
e

(e) Gross sales price		(f) Depreciation allowed (or allowable)	(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a
b
c
d
e

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a
b
c
d
e

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	48,518
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . . . .		3	48,518

Part V

Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income

(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? Yes No

If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.

1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a) Base period years Calendar year (or tax year beginning in)	(b) Adjusted qualifying distributions	(c) Net value of noncharitable-use assets	(d) Distribution ratio (col. (b) divided by col. (c))
2011
2010
2009
2008
2007

2	Total of line 1, column (d) ......................	2
3	Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by the number of years the foundation has been in existence if less than 5 years. . .	3
4	Enter the net value of noncharitable-use assets for 2012 from Part X, line 5.....	4
5	Multiply line 4 by line 3.......................	5
6	Enter 1% of net investment income (1% of Part I, line 27b)...........	6
7	Add lines 5 and 6.........................	7
8	Enter qualifying distributions from Part XII, line 4..............	8
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.

Form 990-PF (2012)

Page 4

Part VI

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)

1a	Exempt operating foundations described in section 4940(d)(2), check hereand enter “N/A” on line 1.
	Date of ruling or determination letter: 1997-08-06(attach copy of letter if necessary–see instructions)
b	Domestic foundations that meet the section 4940(e) requirements in Part V, check	1	N/A
	hereand enter 1% of Part I, line 27b...................
c	All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2............................	3
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-).	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5
6	Credits/Payments:

a	2012 estimated tax payments and 2011 overpayment credited to 2012	6a
b	Exempt foreign organizations—tax withheld at source.......	6b
c	Tax paid with application for extension of time to file (Form 8868)	6c
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7
8	Enter any penalty for underpayment of estimated tax. Check hereif Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2013 estimated tax	Refunded	11

Part VII-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of

the instructions for definition)?............................

If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

Did the foundation file Form 1120-POL for this year?.....................

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. bullet

$ (2) On foundation managers. bullet

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If “Yes,” attach a detailed description of the activities.

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....

Did the foundation have unrelated business gross income of $1,000 or more during the year?........

If “Yes,” has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If “Yes,” attach the statement required by General Instruction T.

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

By language in the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument?................

Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney

General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .

Yes

Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)

or 4942(j)(5) for calendar year 2012 or the taxable year beginning in 2012 (see instructions for Part XIV)?

If “Yes,” complete Part XIV.............................

Yes

Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement (see instructions).................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

N/A

The books are in care of bullet

TIM THOMPSONTREASURER Telephone no. bullet

(207) 778-4745

Located at bullet

204 MAIN STREETFARMINGTONME ZIP+4 bullet

04938

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —Check here......... bullet

and enter the amount of tax-exempt interest received or accrued during the year ...... bullet

At any time during calendar year 2012, did the foundation have an interest in or a signature or other authority over

a bank, securities, or other financial account in a foreign country? .................

See instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet

Form 990-PF (2012)

Page 5

Part VII-B

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.

Yes

During the year did the foundation (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? YesNo

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person?.........................YesNo

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? YesNo

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? YesNo

(5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)?.................YesNo

(6) Agree to pay money or property to a government official? (Exception. Check “No”

if the foundation agreed to make a grant to or to employ the official for a period

after termination of government service, if terminating within 90 days.).........YesNo

If any answer is “Yes” to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations

section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?...

Organizations relying on a current notice regarding disaster assistance check here......... bullet

Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

that were not corrected before the first day of the tax year beginning in 2012?.............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2012, did the foundation have any undistributed income (lines 6d

and 6e, Part XIII) for tax year(s) beginning before 2012?...............YesNo

If “Yes,” list the years bullet

20, 20, 20, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)

to all years listed, answer “No” and attach statement—see instructions.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year?.........................YesNo

If “Yes,” did it have excess business holdings in 2012 as a result of (1) any purchase by the foundation

or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved

by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)

the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine

if the foundation had excess business holdings in 2012.)....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2012?

During the year did the foundation pay or incur any amount to:

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? YesNo

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive?...............YesNo

(3) Provide a grant to an individual for travel, study, or other similar purposes? YesNo

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see instructions)........YesNo

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals?........YesNo

If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......

Organizations relying on a current notice regarding disaster assistance check here......... bullet

If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the

tax because it maintained expenditure responsibility for the grant?............YesNo

If “Yes,” attach the statement required by Regulations section 53.4945–5(d).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract?........................YesNo

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....

If “Yes” to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? YesNo

If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....

Form 990-PF (2012)

Page 6

Part VIII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
Kevin Joyce	Clerk 2.00	0
POBox 31 Farmington,ME04938	Clerk 2.00	0
Kimberly GoochMD	Trustee 2.00	0
232 Clover Mill Road Farmington,ME04938	Trustee 2.00	0
Meredith Kendall	Trustee 2.00	0
39 Goffe Street Lewiston,ME04240	Trustee 2.00	0
Kate Bean	Trustee 2.00	0
POBox 933 Farmington,ME04938	Trustee 2.00	0
Robert Lively	Trustee 2.00	0
POBox 616 Wilton,ME04294	Trustee 2.00	0
Richard Harvey	Trustee 2.00	0
105 Sunny Hill Drive Farmington,ME04938	Trustee 2.00	0
Carolyn Eaton	Trustee 2.00	0
63 Savage Road Industry,ME04938	Trustee 2.00	0
Jan Brinkman	Trustee 2.00	0
POBox 199 West Farmington,ME04992	Trustee 2.00	0
John Bogar	Trustee 2.00	0
314 Morrison Hill Road Farmington,ME04938	Trustee 2.00	0
Robert BeanIII	Trustee 2.00	0
POBox 933 Farmington,ME04938	Trustee 2.00	0
Jeremy Mac Farlane	Trustee 2.00	0
108 Court Street Farmington,ME04938	Trustee 2.00	0
Mary Frank	Trustee 2.00	0
184 Holley Road Farmington,ME04938	Trustee 2.00	0
Tim Thompson	Treasurer 5.00	0
POBox 825 Farmington,ME04938	Treasurer 5.00	0
Patrica Flint	Trustee 2.00	0
93 Fenderson Hill North Wilton,ME04294	Trustee 2.00	0
Joan Patterson	Vice President 5.00	0
110 Court Street Farmington,ME04938	Vice President 5.00	0
Craig Jordan	President 10.00	0
214 Fairbanks Road Farmington,ME04938	President 10.00	0

2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE.”
(a) Name and address of each employee paid more than $50,000	(b) Title, and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
NONE









Total number of other employees paid over $50,000...................

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation
NONE

Total number of others receiving over $50,000 for professional services............. bullet

Part IX-A

Summary of Direct Charitable Activities

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.		Expenses
1	N/A	0
2


3


4

Form 990-PF (2012)

Page 7

Part IX-B

Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.		Amount
1


2


All other program-related investments. See page 24 of the instructions.
3

Total. Add lines 1 through 3.......................... bullet

Part X

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

2,402,514

Average of monthly cash balances.......................

139,494

Fair market value of all other assets (see instructions)................

315,334

Total (add lines 1a, b, and c).........................

2,857,342

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

2,857,342

Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see

instructions) .............................

42,860

Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4

2,814,482

Minimum investment return. Enter 5% of line 5..................

140,724

Part XI

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here bullet

and do not complete this part.)

Minimum investment return from Part X, line 6....................

Tax on investment income for 2012 from Part VI, line 5......

Income tax for 2012. (This does not include the tax from Part VI.)...

Add lines 2a and 2b............................

Distributable amount before adjustments. Subtract line 2c from line 1............

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

Deduction from distributable amount (see instructions).................

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,

line 1................................

Part XII

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

791,283

Program-related investments—total from Part IX-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4

791,283

Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment

income. Enter 1% of Part I, line 27b (see instructions).................

Adjusted qualifying distributions. Subtract line 5 from line 4..............

791,283

Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.

Form 990-PF (2012)

Page 8

Part XIII

Undistributed Income (see instructions)

		(a) Corpus	(b) Years prior to 2011	(c) 2011	(d) 2012
1 Distributable amount for 2012 from Part XI, line 7
2 Undistributed income, if any, as of the end of 2012:
a Enter amount for 2011 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2012:
a From 2007.......
b From 2008.......
c From 2009.......
d From 2010.......
e From 2011.......
fTotal of lines 3a through e.........
4Qualifying distributions for 2012 from Part
XII, line 4: $
a Applied to 2011, but not more than line 2a
b Applied to undistributed income of prior years (Election required—see instructions)......
c Treated as distributions out of corpus (Election required—see instructions).........
d Applied to 2012 distributable amount.....
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2012.
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years’ undistributed income. Subtract line 4b from line 2b ...........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2011. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2012. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2013 ..........
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (see instructions) .............
8Excess distributions carryover from 2007 not applied on line 5 or line 7 (see instructions) ...
9Excess distributions carryover to 2013. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2008....
b Excess from 2009....
c Excess from 2010....
d Excess from 2011....
e Excess from 2012....

Form 990-PF (2012)

Page 9

Part XIV

Private Operating Foundations (see instructions and Part VII-A, question 9)

1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2012, enter the date of the ruling....... bullet

1997-08-06

b Check box to indicate whether the organization is a private operating foundation described in section4942(j)(3) or4942(j)(5)

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2012	(b) 2011	(c) 2010	(d) 2009	(e) Total
	89,646	132,967	80,522	39,949	343,084
b 85% of line 2a .........	76,199	113,022	68,444	33,957	291,622
c Qualifying distributions from Part XII, line 4 for each year listed .....	791,283	727,747	688,736	668,459	2,876,225
d Amounts included in line 2c not used directly for active conduct of exempt activities ....
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....	791,283	727,747	688,736	668,459	2,876,225
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets” alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment” alternative test— enter 2⁄3 of minimum investment return shown in Part X, line 6 for each year listed...	92,878	87,758	94,272	104,515	379,423
c “Support” alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

Part XV

Supplementary Information (Complete this part only if the organization had $5,000 or more in
assets at any time during the year—see instructions.)

1Information Regarding Foundation Managers:

aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here bullet

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.

aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:

The Farmington Home for Aged People
204 Main Street
Farmington,ME04938

bThe form in which applications should be submitted and information and materials they should include:

A written request that includes the name,address,telephone number of the person or organization making the request.

cAny submission deadlines:

None

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

None

Form 990-PF (2012)

Page 10

Part XV

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year

Total ................................. 3a

bApproved for future payment

Total ................................. 3b

Form 990-PF (2012)

Page 11

Part XVI-A

Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments....
3Interest on savings and temporary cash investments					166
4 Dividends and interest from securities....					69,510
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6Net rental income or (loss) from personal property
7 Other investment income.....
8Gain or (loss) from sales of assets other than inventory					48,518
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory..
11 Other revenue: aResident Fees					715,549
bOther Income
c
d
e
12 Subtotal. Add columns (b), (d), and (e)..					833,743

13Total. Add line 12, columns (b), (d), and (e)..................

13833,743

(See worksheet in line 13 instructions to verify calculations.)

Part XVI-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)
11	Medicaid payments and resident fees provide the necessary funds to operate the facility and perform elderly care services.
348	Interest and dividends and rental income provide funds to offset operating expenses for the organization.

Form 990-PF (2012)

Page 12

Part XVII

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Did the organization directly or indirectly engage in any of the following with any other organization described in section

Yes

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........YesNo

If “Yes,” complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below (see instr.)? Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name Firm's address			Firm's EIN
				Phone no.

Form 990-PF (2012)

Additional Data

Software ID:	12000229
Software Version:	2012v2.0

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2012 AccountingFeesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Accounting Fees	9,680	0	0	9,680

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

TY 2012 DepreciationSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense
EQUIPMENT (MISC)	2012-11-30	893		91	10.0000	45
REFRIGERATOR (CJ)	2012-11-14	1,650		91	10.0000	96
APPLIANCE (CJ)	2012-10-26	800		91	10.0000	47
COPYSTAR 2050	2012-10-18	600		91	10.0000	35
TELEPHONE LINE	2012-10-01	509		91	39.0000	9
SMOKE DETECTORS (SIMPLEX)	2012-10-01	5,319		91	39.0000	91
EASTERN FIRE SERVICES	2012-08-30	4,588		91	39.0000	88
RANGE GUARD	2012-07-31	1,596		91	39.0000	34
2006 CHRYSLER 300	2012-09-21	16,934		91	7.0000	1,613
EQUIPMENT	2012-05-30	1,433		91	10.0000	143
PROTABLE ICE MAKER	2012-05-30	229		91	10.0000	23
ARM CHAIRS (2)	2012-04-17	770	6	91	10.0000	77
FURNITURE (BOUFFORDS)	2011-11-25	270	14	91	10.0000	27
EQUIPMENT (SEARS)\	2011-08-02	300	25	91	10.0000	30
SEWER LINE - BASEMENT	2012-01-11	3,200	34	91	39.0000	82
IMPROVEMENTS- PAINT EXT.	2011-06-28	5,120	120	91	39.0000	131
SECURITY SYSTEM	2010-12-16	898	127	91	10.0000	90
COMPUTER - HEC ATX	2010-11-17	1,107	166	91	10.0000	111
BOX SPRING	2010-09-30	135	23	91	10.0000	14
COMPUTER - AMD SEMPRON	2010-08-05	525	97	91	10.0000	53
VACUUM CLEANER	2010-07-29	285	53	91	10.0000	29
AIRCONDITIONER	2010-07-15	374	71	91	10.0000	37
ELECTRICAL IMPROVEMENTS	2010-12-14	2,156	83	91	39.0000	55
DOOR INSTALATION	2010-10-06	468	20	91	39.0000	12
KITCHEN RENOVATION	2010-08-25	21,597	969	91	39.0000	554
EQUIPMENT (B of A)	2010-05-31	511	102	91	10.0000	51
COMMUNICATION SYSTEM	2010-04-09	6,393	1,385	91	10.0000	639
EQUIPMENT (B of A)	2009-11-06	2,795	723	91	10.0000	280
NEW SIGN	2009-10-22	755	196	91	10.0000	76
FURNACE	2010-05-25	4,427	228	91	39.0000	114
PORCH FLOOR	2010-04-09	3,940	219	91	39.0000	101
ELECTRIC IMPROVE.	2010-04-08	1,424	80	91	39.0000	37
DRYER VENTING	2010-03-18	693	39	91	39.0000	18
PORCH AWNING	2010-04-09	8,866	492	91	39.0000	227
IMPROVE. (FARM. CONST)	2009-12-10	4,947	317	91	39.0000	127
ICE MAKER	2009-05-29	200	70	91	10.0000	20
EQUIPMENT	2009-05-07	374	130	91	10.0000	37
DRYER	2008-12-16	575	203	91	10.0000	58
LAPTOP	2008-12-10	400	140	91	10.0000	40
EQUIPMENT	2008-10-08	1,500	525	91	10.0000	150
EQUIPMENT	2008-07-31	120	42	91	10.0000	12
AIR CONDITIONER	2008-06-09	274	95	91	10.0000	27
EQUIPMENT	2007-12-05	566	256	91	10.0000	57
SIMPLEX	2007-09-26	6,052	2,823	91	10.0000	605
COMPUTER	2007-10-31	2,332	1,068	91	10.0000	233
EQUIPMENT	2007-07-27	400	193	91	10.0000	40
APPLIANCES	2007-06-27	890	438	91	10.0000	89
EQUIPMENT	2007-05-14	449	229	91	10.0000	45
EQUIPMENT	2007-04-02	257	134	91	10.0000	26
EQUIPMENT	2007-03-12	1,230	646	91	10.0000	123
EQUIPMENT	2007-03-02	1,340	704	91	10.0000	134
EQUIPMENT	2007-02-05	1,398	747	91	10.0000	140
EQUIPMENT	2007-02-02	348	187	91	10.0000	35
EQUIPMENT	2007-01-22	500	267	91	10.0000	50
EQUIPMENT	2007-01-05	729	395	91	10.0000	73
EQUIPMENT	2006-10-27	1,650	921	91	10.0000	165
EQUIPMENT	2006-09-06	200	115	91	10.0000	20
EQUIPMENT	2006-08-04	510	297	91	10.0000	51
EQUIPMENT	2006-07-19	2,339	1,365	91	10.0000	234
EQUIPMENT	2005-11-15	2,071	1,363	91	10.0000	207
FURNITURE UPHOLSTERING	2005-04-10	1,000	717	91	10.0000	100
EQUIPMENT	2005-01-12	309	230	91	10.0000	31
FURNITURE	2004-09-15	1,600	1,240	91	10.0000	160
COPIER	2004-10-27	2,480	1,881	91	10.0000	248
DESK CHAIR	2004-09-29	418	322	91	10.0000	42
EQUIPMENT	2004-06-29	925	732	91	10.0000	93
SOUND SYSTEM	2003-12-03	2,421	2,057	91	10.0000	242
EQUIPMENT	2004-02-29	247	206	91	10.0000	25
EQUIPMENT	2004-02-04	500	417	91	10.0000	50
FURNITURE	2003-11-18	545	467	91	10.0000	55
EQUIPMENT	2003-07-15	300	268	91	10.0000	30
APPLIANCES	2003-06-16	1,745	1,560	91	10.0000	175
TABLES & CHAIRS	2003-08-16	7,113	6,221	91	10.0000	711
WATER HEATERS	2003-05-20	4,220	3,833	91	10.0000	387
TRACTOR	2003-04-14	3,699	3,392	91	10.0000	307
DISHWASHER	2003-04-09	2,800	2,567	91	10.0000	233
BUILDING EXPANSION	1995-09-01	717,236	600,688	91	20.0000	35,862
ELECTRIC IMPROVE.	2008-10-30	397	36	91	39.0000	10
ELECTRIC IMPROVE.	2008-09-15	1,613	152	91	39.0000	41
PAVING	2007-10-15	2,500	296	91	39.0000	64
IMPROVEMENTS	2007-06-22	900	114	91	39.0000	23
IMPROVEMENTS	2008-05-30	410	44	91	39.0000	11
IMPROVEMENTS	2007-12-14	435	49	91	39.0000	11
IMPROVEMENTS	2007-12-13	4,500	513	91	39.0000	115
IMPROVEMENTS	2007-08-22	5,200	638	91	39.0000	133
IMPROVEMENTS	2007-06-11	7,500	952	91	39.0000	192
IMPROVEMENTS	2007-03-12	4,657	620	91	39.0000	119
ELECTRIC IMPROVE.	2007-02-19	367	48	91	39.0000	9
IMPROVEMENTS	2006-03-08	4,828	770	91	39.0000	124
IMPROVEMENTS	2006-01-27	12,592	2,059	91	39.0000	323
IMPROVEMENTS	2005-12-12	7,647	1,266	91	39.0000	196
IMPROVEMENTS	2005-10-10	1,804	305	91	39.0000	46
IMPROVEMENTS	2005-08-01	6,446	1,121	91	39.0000	165
IMPROVEMENTS	2004-10-24	17,666	3,435	91	39.0000	453
IMPROVEMENTS	2004-04-30	835	339	91	20.0000	42
IMPROVEMENTS	2004-05-04	15,042	6,079	91	20.0000	752
IMPROVEMENTS	2003-10-22	8,120	3,485	91	20.0000	406
CURTAINS	2002-09-18	2,915	1,876	91	15.0000	194
IMPROVEMENTS	2002-10-30	4,884	2,338	91	20.0000	244
CARPET	2002-04-09	4,013	2,713	91	15.0000	268
ELECTRIC IMPROVE.	2001-08-19	1,713	1,226	91	15.0000	114
IMPROVEMENTS	2000-11-16	2,252	1,725	91	15.0000	150
ADDITIONS	1998-11-30	40,036	36,032	91	15.0000	2,669
THIRD FLOOR RENOVATION	1998-04-30	22,600	15,914	91	20.0000	1,130
FURNACE	1997-06-30	15,025	11,203	91	20.0000	751

- TIN:

TY 2012 LandEtcSchedule2

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Category / Item	Cost / Other Basis	Accumulated Depreciation	Book Value	End of Year Fair Market Value
Land	12,100		12,100	12,100
Buildings	1,297,697	1,059,649	238,048	1,297,697
Machinery and Equipment	91,694	63,859	27,835	91,694
Auto./Transportation Equip.	16,934	1,613	15,321	16,934

- TIN:

TY 2012 MortgagesAndNotesPayableSch

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Total Mortgage Amount: 105000

- TIN:

TY 2012 OtherAssetsSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
Rounding		1
Net Intangible Assets	2,535	1,267	1,268

- TIN:

TY 2012 OtherExpensesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Description	Revenue and Expenses per Books	Disbursements for Charitable Purposes
Residents' Medical Expenses	2,326	2,326
Repairs & Maintenance	42,898	42,898
Medicaid Repaid	30,256	30,256
Insurance	26,411	26,411
Household Activities	18,348	18,348
Health Insurance	75,225	75,225
Food & Provisions	58,761	58,761
Casual Labor	400	400
Amortization	1,268
Administrative Expense	18,024	18,024

- TIN:

TY 2012 OtherIncomeSchedule2

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Description	Revenue And Expenses Per Books	Net Investment Income	Adjusted Net Income
Resident Fees	715,549

- TIN:

TY 2012 OtherIncreasesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Description	Amount
Change in Restricted Assets	552

- TIN:

TY 2012 OtherProfessionalFeesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Other Professional Fees	21,583	13,998	13,998	7,585

- TIN:

TY 2012 TaxesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:12000229

Software Version:2012v2.0

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Payroll Taxes	33,692	1,685	1,685	32,007
Maine Provider Tax	6,104			6,104